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FOR OFFICE USE: --------------------------------------------------------- p --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- -- ------ -------------------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. f Q-ZkF7 I a -- . •-• ---- JOB ADDRESS LOCATION.YW,, L' u�/�/1/,C2 �, Owner�s NamW,.*Ir---- rC�L- `-:--mer-----•--- ------- ------------------------ --- Phone- '- ' Address - . > =: - -----•---------------------------------•------------------------------ Contractor's Name j � ----------. Phone...-- _---------- --------------- -- - - ---------------•-•-- •- Installation will serve: Residence e,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�____ Number of bedrooms 3--_._ Number f baths y�Lot size ___ - -________________---_-.--_--- Water, Supply: Public system ❑ Community system ❑ Private [Depth to Water Table --__._ ft. Charal ter of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam [Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: llf yes,date--------- ..---1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 'I TYPE--OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic; Tank: Distance from nearest well__�r- .f.J____Distance from f�ndafi n__-_--12-_--._.Mater -.��----------- deph_--_ Capacity_/�6 Field: Dueearest � / � aatio ____ --T- '_'_' ctnearest nNo. of compartments.__----�---- ------ Disposal gjX-J ------- Number mbeof lines --------------------- ength of each lin � WidthoftrenchJ/ Type of filter material-_ _c5�R ----Depth of filter material-----f Total length__._ .L�- --------- --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------.-------------Distance to-nearest lot line----------------- N F1.1 Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth-------.------------------------- . Cesspool: Distance from nearest well--------------__Distance from foundation--------------------Lining material-_._-__-----------------.-----__-----. dSize: Diameter--------------------------------------Depth--------------------------------- --- --------------Liquid Capacity----------------------------gals. - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------.-_--_----- ❑ Distance to nearest lot line------------------------- ------ ---------------------------------------------------------------------------- ------ Remideling'and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------•-----•----------------------------------------------------•--------------------------------------------------------------------------------- ----------------------------------------------------------------- )�------------------------------------------ -----------------------------•-----------------------•----•------ ----------------------------------------------------------------------------------------------- ---- 1 I1hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. II (Signed)-------- ---------- -------- -- -- --- - - ------- - ------- --- ----- ---------- ------------------------------------------------------------- r and/or Contractorl _1------- -- -------------r_9-------------------------------------------------- [Title)- -. ._. .. . .,-------------- By:.-- (Plot plan, showing size of lot, location o system i rH elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - �-"'� - ------------------------------------------------------ DATE �- Z-�-��- ---------------------- REVIEWEDBY---------------------------------------------------- -------------- --------------------------------------------------------- DATE----------------------------------------•--------•--------- BUILDINGPERMIT ISSUED---------------------------------------------- ------------------------------------------------------ DATE------------------------------------------------------------- Alterahionsand/or recommendations--- ------------------------------------------------------------------------------------------•--------•--------------------•---------------------------------- i ------------------------------- --------------------------------------------- ------------------------------•--------------------------------------------------------•---------------------------------- ------------------------------------------------ ---------- -------------------------------------------------------------------------- ------- ------------------------------------------------------------------------- I� I FINAL INSPECTION BY:. - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-S9 3M 3-•63 F.P.CD.